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General NPI Number Information
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NPI Number | 1437159886
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Entity Type | Individual
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Provider Name | AMY HALLAL HENDERSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 06/14/2016
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Provider Practice Location Address
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Address Line | 2 SILVERCREST DR SUITE 100
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City | NEW ALBANY
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State | IN
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Zip | 47150-7800
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Country | US
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Telephone | 812-948-1641
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Fax | 812-941-0438
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Provider Business Mailing Address
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Address Line | 2 SILVERCREST DR SUITE 100
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City | NEW ALBANY
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State | IN
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Zip | 47150-7800
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Country | US
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Telephone | 812-948-1641
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Fax | 812-941-0438
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 01052944A
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License Number State | IN
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